Urinary Incontinence and Aging

What is Incontinence?

Incontinence is the inability to control one's own urinary functions. People who are incontinent urinate on themselves before they get to a toilet.

National statistics show that more than 60% of all nursing home residents are incontinent. Unfortunately, incontinence is often ignored because it is considered a normal aging change, but it isn't. Most incontinence can be managed or treated.

Incontinence is Treatable

Many treatable problems contribute to incontinence. Some residents have several coexisting problems that contribute to the problem. Both must be treated, or the incontinence will persist. Un-treated incontinence also increases the risk ofpressure sores.

The Cause of Incontinence

Recognizing the need to urinate is one of the last neurological sensations to be lost in mentally confused residents. More often than not, incontinence is really a problem of communication. Mentally confused residents may not be able to convey the need to use the bathroom except throughextreme behavior, such as screaming, pulling at clothing, and disrobing. The resident will likely calm down after he or she has urinated or after any wet clothing has been changed.

Primary Causes of Incontinence

Some primary causes of incontinence include:

Urinary tract infection
Constipation or fecal impaction
Medications, including diuretics
Inadequate fluid intake
Communication problems
Muscular weakness
Lack of access to the bathroom or obstacles blocking access
Inability to walk or propel wheelchair to the bathroom
Inability to remove clothing once in the bathroom
Restraints
Prostate problems in males
Chronic illness, disease, and trauma
Loss of motivation to correct the problem
Depression
Congestive heart failure
Swelling in the feet and legs
Recent stroke
Bladder cancer

Secondary causes of incontinence include:

Bladder pain
Low urine output (incontinence is worse if output is less than 1000 cc (one quart) over 24 hours
Excessive fluid intake
Diabetes
Estrogen depletion

Types of Incontinence

There are several types of urinary incontinence. Incontinence can be caused by mental or medical conditions.

Stress incontinence

Stress incontinence is most common in women. During stress incontinence, the urethral sphincter fails to hold urine because of increased pressure, caused by having multiple children, muscle weakness, and aging. Elderly nursing home residents with stress incontinence inadvertently leak when they laugh, cough, sneeze, change position, stand, lift or engage in some other physical activity.

Overflow incontinence

Overflow incontinence is commonly seen in males with prostrate problems and all residents with neurological problems.

Functional incontinence

Functional incontinence results from the physical or mental inability to urinate. Restraints or the inability to get a toilet affect the physical ability, while lack of communication skills affect the mental ability. The resident may show signs of urge incontinence.

Reflux Incontinence

Unconscious, or reflux, incontinence is a neurological dysfunction. The nursing home resident may not be aware of the need to urinate, depending on the cause of the problem. The resident is frequently or continuously incontinent, and may experience severe urgency and bladder hypersensitivity.

How to Prevent Incontinence

Curb any negative reactions to the nursing home resident's incontinence. Incontinence is a medical problem beyond the resident's control.
Body language, actions, or words indicating disgust are hurtful to all incontinent nursing home residents.
Don't say "diaper" when referring to the medical aids used to manage incontinence. Instead, use the brand name, refer to it just as you would a regular undergarment, or call the item an adult brief, garment protector, or clothing protector.
Ask nursing home residents if they need to use the bathroom. Help them do so if necessary.
Ask residents if they need to have an adult brief changed or have bedclothes and sheets laundered.

Incontinence and Nursing Home Staff Responsibilities

How can the nursing home staff help manage incontinence?

Take residents to the bathroom (or remind ones who are able) on a regular, scheduled basis.
Ensure that the toilet seat is at least 17 inches from the floor, that the toilet has arms or railings at least 10 inches above the seat, and that there are no physical barriers between the nursing home resident and the bathroom.
Evaluate the resident's incontinence pattern over 7 to 14 days, and design a management plan to correct the problem. A cure won't be visible overnight, but consistent management should eventually cure or curb incontinence.
Ensure proper fluid intake.
Discuss incontinence treatment options with the nursing home resident and/or their family.

Prevention of Incontinence

Staff members in long term nursing home care facilities are often not very sympathetic when dealing with a resident's incontinence problems, and they may feel it is futile to try to prevent the incontinence. However, nursing home staff can, and should, help residents to prevent or curb incontinence problems.

In some cases, incontinence problems may be corrected simply by treating the underlying problem, and possibly retraining or managing the resident's needs. This approach will usually work for incontinence caused by high blood sugar (hyperglycemia), excess fluid intake, inadequate fluid intake, volume overload, venous insufficiency with fluid retention, congestive heart failure, and delirium. Similarly, incontinence caused by psychological or physical impairments can be managed by treating the underlying problem and by making sure toilet facilities are accessible and usable.

Incontinence that is caused by urinary tract infection usually responds to antibiotic treatment, though retraining may still be necessary after the infection is cleared up. If fecal impaction is leading to incontinence, remove the impaction. Then regularly use stool softeners and bulk forming agents, increase the fluids and fiber in the resident's diet, and encourage or assist him or her to get adequate exercise.